The Application

For thirty-seven years, the standard treatment for hair loss was a liquid you applied directly to your scalp twice a day.

It was called Rogaine. The active ingredient was minoxidil. It was FDA-approved in 1988. You rubbed it on your head. Some of it went where it was supposed to go. Some of it did not. The instructions said to apply it twice daily. Studies found that most patients did not do this, because most patients had lives.

Last week, researchers published results from a large clinical trial. Oral minoxidil — a pill — produced significantly better results than the topical version.

(Oral minoxidil has been available as a generic blood pressure medication since the 1970s. Doctors have been prescribing it off-label for hair loss for years. A three-month supply costs approximately twelve dollars. The researchers did not address why no major trial had been conducted earlier. That question was not part of the study design.)

The pill is taken once a day. It does not require applying anything to your scalp. It does not have compliance issues. It goes into your body the way pills go into bodies.

The topical solution, for thirty-seven years, went onto your head with your fingers.

I want to be precise about the timeline here. The pill version of this drug and the topical version of this drug were both available, in generic form, at approximately the same time. One of them became the standard of care. One of them became a two-dollar-per-month blood pressure medication with a hair side effect that nobody had formally investigated in a large trial.

(The branded version of the topical solution, during this period, cost between thirty and fifty dollars a month. The branded version is currently available. There is no branded version of the pill because the pill is a forty-year-old generic blood pressure medication. These facts are stored in separate systems.)

The dermatologist will tell you about the pill option. The topical solution will continue to be available. The review period was thirty-seven years. The review is now complete.